Fillable 2021 Application For Real Property Tax Exemption Jackson

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2021 Application For Real Property Tax Exemption Jackson

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2021 Application For Real Property Tax Exemption
– Jackson County, Missouri –
1
Name of the Organization: ________________________________________________________
Contact Name: _________________________________________________________________
Mailing Address: _______________________________________________________________
City: __________________________ State: ____________________ Zip: ____________
Office Phone: _________________________ Alternate Phone: __________________________
E-mail Address: ________________________________________________________________
Situs Address (physical location of property):
______________________________________________________________________________
Parcel Identification Number: __________-________-________-____-____-____-______-____
1. Type of organization (e.g., church, school, civic, medical, fraternal, educational, etc.)
______________________________________________________________________________
2. Is the owner exempt from state and federal income tax?
( ) Yes, under IRS code 501(c) _______.
( ) No.
3. Is the organization that is applying for this exemption the legal deed holder?
( ) Yes.
( ) No, the legal deed holder is: ______________________________________________
4. For what activities is the property used? (Be detailed and specific as to the activities and use
of this property only. Do not give broad conclusions, such as “charitable”, “worship” or
“public use”.) Attach additional sheets if necessary.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
5. On what date did this use begin (listed in 4. above)? _________________________________
6. What is the contemplated future use of the property? _________________________________
______________________________________________________________________________
2021 Application For Real Property Tax Exemption
– Jackson County, Missouri –
2
7. Is the owner or applicant an L.L.C.?
( ) Yes. Please respond to A-D below.
( ) No.
A. Provide a list of your members.
B. Are all LLC members’ non-profit organizations? ( ) Yes ( ) No
C. Does the State and Federal Government consider the owner/applicant a
disregarded entity? ( ) Yes ( ) No
D. Does the LLC file federal tax form #8832? ( ) Yes ( ) No
8. Who are the people benefiting from or served by the use of the property? ________________
______________________________________________________________________________
9. Does the property generate any income (other than donations)?
( ) Yes. Please respond to A & B below.
( ) No.
A. From what source is the income generated (e.g. rentals, leases, fees for services)?
Please provide leases or agreements from all sources of income.
______________________________________________________________________________
______________________________________________________________________________
B. What is the income used for? __________________________________________
10. Is there any other organization or business using this property?
( ) Yes. Please give details on a separate sheet of paper including who uses the property
and for what purpose.
( ) No.
11. Is any part of the property used as a residence?
( ) Yes. Please respond to A-D below.
( ) No.
A. Who uses the property as their residence?
______________________________________________________________________________
B. Resident(s) connection with the organization.
______________________________________________________________________________
C. Duties of the resident(s) in connection with the property.
______________________________________________________________________________
D. Schedule of rents charged or financial arrangements for residency.
______________________________________________________________________________
2021 Application For Real Property Tax Exemption
– Jackson County, Missouri –
3
12. Do you charge a fee for any of the services you provide?
( ) Yes. Please respond to A-D below.
( ) No.
A. Provide your fee schedule including any discounts or sliding scales.
B. Provide a copy of your policy that is used to determine who receives services at a
reduced rate.
C. What percentages of your services are provided to those who cannot personally
pay? ________%
D. What percentages of your expenses are attributed to your charity/indigent
services? ________%
13. Does your organization deny services or turn away anyone?
( ) Yes. Provide the circumstances that determine the denial of services on a separate
paper.
( ) No.
14. Please provide all documents listed below, that apply to the applicants’ organization.
A. Articles of Incorporation and all amendments.
B. Missouri non-profit corporation status from the Secretary of State.
C. Tax-exempt determination by the IRS.
D. The organization’s constitution, regulations, or by-laws and all amendments.
E. A current list of all officers, directors, trustees, etc. of the organization.
F. The applicant’s income and expense statement for the two most recent tax years.
G. Documentation supporting the use of the property as of January 1 of the current year.
H. A copy of advertisements, brochures, postings or other notifications of activities
benefitting the community at large or to those receiving indigent services.
I. Supporting documentation that the applicant’s contributions received are tax deductible.
***If the applicant is an LLC please contact us for additional required documents***
2021 Application For Real Property Tax Exemption
– Jackson County, Missouri –
4
COMPLETE AND RETURN TO:
Assessment@jacksongov.org
OR
ASSESSMENT DEPARTMENT
ATTN: Exemptions
415 East 12
th
Street, Ste. 1M
Kansas City, Missouri 64106-2752
(Any questions contact: 816-881-3483)
REFERENCE FOR EXEMPTIONS: SECTION 137.100 AND 137.101, RSMO. ARTICLE X,
SECTION 6, MO CONST. AND APPLICABLE CASE LAW.
The undersigned declares that all of the statements and representations in this application are
within their personal knowledge and are true.
Note: Pursuant to state statute 575.050 and 575.060 RSMO, making a false affidavit or a
false declaration is a misdemeanor and subject to criminal punishment.
Applicant or representative (printed): _______________________________________________
Applicant or representative signature: ____________________________ Date: ______________
Title: _________________________________________________________________________
Rev. 09/2020
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2021 Application For Real Property Tax Exemption Jackson

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Completed 24 June 2021

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